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    Intentional anisometropia creation treats diplopia

    Innovative strategy makes inability to fuse a cure rather than a complication


    Chicago—Planned anisometropia in patients with long-standing diplopia who are undergoing bilateral cataract surgery can be a triple-win situation, providing clear uncorrected vision at both distance and near while simultaneously eliminating or reducing awareness of pre-existing double vision, according to Robert H. Osher, MD.

    Dr. Osher
    He described this innovative surgical solution for double vision at the annual meeting of the American Society of Cataract and Refractive Surgery.

    The approach, which aims for a plano outcome in the distance eye and myopia between –3 and –3.5 D in the near eye, creates an amount of anisometropia incompatible with binocular vision. Although such an outcome is considered a disaster after conventional cataract surgery, experience with it in a series of 12 patients demonstrates it is a safe and consistently successful strategy when used in carefully selected patients with long-standing acquired diplopia.

    "Missing the diagnosis of pre-existing diplopia and leaving a patient with too much anisometropia are considered two of the top perils of cataract surgery because of their postoperative consequences," said Dr. Osher, professor of ophthalmology, University of Cincinnati, and medical director emeritus, Cincinnati Eye Institute.

    "When patients with diplopia undergo cataract surgery, even if they have two perfect operations, they may be unhappier postoperatively . . . because they will become more acutely aware of the now-clear second image, which may be impossible to suppress," he said. "Leaving pseudophakic patients with too much anisometropia is also a huge problem because these individuals will be bothered by aniseikonia."

    However, several years ago, Dr. Osher was spontaneously struck with the idea that leaving a patient unable to fuse by deliberately creating anisometropia could have positive consequences in a person with diplopia.


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